Electronic Medical Records to Improve Patient Care & Public Health in Rural Kenya

描述（由申请人提供）： 医疗保健是一个信息密集型、复杂的过程。整合提供者和站点之间的护理需要整合医疗保健信息。发展中国家的医疗保健得不到电子病历系统 (EMR) 的充分支持，处于数字鸿沟的另一端。 因此，无法获得数据来提高护理质量和效率。来自印第安纳大学、Regenstrief Institute 的开发人员及其在肯尼亚莫伊大学的合作者创建了撒哈拉以南非洲地区第一个流动电子病历系统，该系统为（并且仍在为）肯尼亚西部的一个农村卫生中心提供服务。该系统随后催生了撒哈拉以南非洲地区艾滋病毒/艾滋病诊所中使用最广泛、最全面的电子病历系统：OpenMRS。尽管在肯尼亚西部，大多数艾滋病毒/艾滋病诊所位于也设有初级保健诊所的公共卫生设施内，但艾滋病毒/艾滋病信息系统不包含这些初级保健诊所的数据，因此初级保健和艾滋病毒/艾滋病护理是分开进行的，没有整合。然而，这些卫生中心的初级保健和艾滋病毒/艾滋病诊所都在照顾相同的患者，而在获得护理总是充满挑战的发展中国家，每次就诊都是提供以患者为中心的初级和专科护理的机会。 该项目将把最初创建 OpenMRS 的 Mosoriot 医疗记录系统合并回 OpenMRS。它将证明，单一的集成电子病历可以支持初级护理和艾滋病毒/艾滋病护理，并成为这两种类型诊所护理的有效工具。一旦整合，开发人员将证明，简单的决策支持工具（例如计算机提醒）将提高对初级保健和艾滋病毒/艾滋病护理准则的遵守，例如（a）防止艾滋病毒从怀孕母亲传播给婴儿（具体来说，增加适当进行艾滋病毒筛查的妇女及其婴儿的数量），（b）确保感染艾滋病毒的儿童得到适当的预防性护理（具体来说，接受适当的免疫接种），以及（c）协调对同时感染艾滋病毒的成人和儿童的护理和结核病（具体来说，增加完成适当治疗和随访的合并感染患者的数量）。合并的初级/艾滋病毒/艾滋病电子病历对提供者生产力和时间管理的影响也将得到衡量。 为发展中国家的艾滋病毒/艾滋病护理提供资金的机构已经意识到，支付护理费用需要支付高质量电子数据的收集和管理费用。该项目将了解此类电子病历是否也可以用于以最低的额外成本支持初级保健（如果可以大规模证明 Mosoriot 医疗保健提供者生产力提高的初步证据，也许可以节省成本）。如果是这样，那么只要艾滋病毒/艾滋病护理得到资助，并且可以继续使用电子病历来管理和改善艾滋病毒/艾滋病和初级保健，这种电子病历就将是可持​​续的。

DESCRIPTION (provided by applicant): Health care is an information-intensive, complex set of processes. Integrating care between providers and sites requires integrating health care information. Health care in developing countries has been inadequately sup- ported with electronic medical record systems (EMRs), being on the far side of the digital divide. As a result, data are not available to enhance the quality and efficiency of care. Developers from Indiana University, the Regenstrief Institute, and their collaborators at Moi University in Kenya created sub-Saharan Africa's first ambulatory electronic medical record system that served (and still serves) a rural health centre in western Kenya. This system then gave birth to what has become the most widely implemented, comprehensive electronic medical record system used in HIV/AIDS clinics throughout sub-Saharan Africa: OpenMRS. Although in western Kenya most of the HIV/AIDS clinics are in public health facilities that also contain primary care clinics, the HIV/AIDS information system does not contain data from these primary care clinics, and therefore primary care and HIV/AIDS care happens separately, without integration. Yet both primary care and HIV/AIDS clinics in these health centres are caring for the same patients, and each visit in developing countries where access to care is always challenging is an opportunity to provide patient-focused primary and specialty care. This project will merge the Mosoriot Medical Record System, from which OpenMRS was originally created, back into OpenMRS. It will demonstrate that a single integrated EMR can support both primary and HIV/AIDS care and become an effective tool for care in both types of clinics. Once integrated, the developers will demonstrate that simple decision-support tools such as computer reminders will increase adherence to both primary care and HIV/AIDS care guidelines, such as (a) preventing transmission of HIV from pregnant mothers to their infants (specifically, increasing the number of women and their infants appropriately screened for HIV), (b) ensuring that HIV-infected children receive appropriate preventive care (specifically, receiving appropriate immunizations), and (c) coordinating care for adults and children co-infected with HIV and tuberculosis (specifically, increasing the number of co-infected patients completing appropriate treatment and follow-up). The effect of the merged primary/HIV/AIDS EMR on provider productivity and time management will also be measured. The agencies funding HIV/AIDS care in developing countries have realized that paying for care requires paying for the collection and management of high-quality electronic data. This project will discern whether such EMRs can also be used to support primary care at minimal additional cost (and perhaps be cost-saving if preliminary evidence of increased productivity of Mosoriot's health care providers can be demonstrated on a larger scale). If so, then such EMRs will be sustainable as long as HIV/AIDS care is funded, and the use of EMRs to manage and improve HIV/AIDS and primary care can be maintained.